The Rose Colored Crystal Ball

I'm not an incurable pessimist. Here is some good news in public health that we can expect, or at least hope for, in 2006.

Eradication of polio: WHO came very close to eradicating polio a couple of years ago, but an outbreak in West and Central Africa in mid-2003, complicated by resistance of some religious leaders to immunization, set the effort back. It's on track again. That outbreak is now controlled. A new oral vaccine has proved very useful in India and Egypt, the two places where control of polio has been technically most difficult. WHO now expects to stop polio transmission everywhere on earth except Nigeria by mid-2006, and to finish the job in Nigeria by the end of the year.

Human Papilloma Virus Vaccines: HPV is a sexually transmitted disease which also happens to be the cause of nearly all cases of cervical cancer. Vaccines are under development against the most common pathogenic strains of HPV. These will begin to become available very soon, and could eliminate most HPV infections and cervical cancer in developed countries, although getting them to women in poor countries is obviously still a problem. (There are religious fanatics who oppose their use on the grounds that if women don't have to worry about HPV, they'll have less incentive to be chaste. All I can say is, some people are really sick and twisted.)

Tobacco: Tobacco use in the U.S. continues to decline, albeit painfully slowly.



The confusing thing about the graphic is that there are more people who report smoking a few cigarettes a day, but there are definitely fewer heavy smokers. One likely explanation is the increasing prevalence of workplace smoking bans, which force smokers to cut down. People who smoke fewer cancer sticks will also find it easier to quit entirely. The more cities and states that pass bans on smoking in public places, particularly restaurants and bars, the more people will quit, and the less children will perceive that smoking is a normal, adult activity. The bad news is that the merchants of death are targeting less developed countries, and global tobacco use is increasing.

Pandemic flu preparedness: We aren't close to being ready, but at least in 2005 government and the corporate media emerged from their delusional state in which the greatest threat to public health was imagined to be bioterrorism, and started paying attention to more probable dangers. People are thinking about pandemic flu (not always very clearly -- I'll have more to say about that later) and in a few years, we may even have a vaccine production capacity based on cell cultures instead of chicken eggs, which will give the world a realistic chance to control a future pandemic. It might be too late for the next Big One, but still . . .